At any given meeting of the Board of Mayor and Aldermen, dozens of items come up for votes, and many are passed without discussion - especially if there is something controversial on the agenda like, say, the tax cap. This, of course, was the main event at Tuesday's meeting, which stretched past 1 a.m.

And so it was that the aldermen OK'd a pretty important document without a word of debate - a request for proposals for its emergency ambulance service.

For more than a year, the current ambulance company, American Medical Response (AMR), has been the target of complaints over large bills - topping $2,000 for a trip to the hospital - and aggressive billing practices.

In response, the fire department, which oversees the ambulance contract and works closely with the company in responding to 911 calls, has proposed an in-house ambulance service. Last month, the department proposed putting out an new RFP for a private company, while making the transition to an in-house service over five years.

However, unlike the draft RFP discussed in committee last month, the final version approved by the aldermen Tuesday eliminates any mention of a transitional plan. The department is not being considered as the ambulance provider at this point.

The RFP also differs in another important respect: Rather than negotiating the fees, the department would charge the contractor for "dispatch services," it puts them down in black and white.

Under the proposed contract, the fee would start at $325,000 in 2014 and steadily rise to $372,892 in Year 5. In addition, there would be an unspecified annual fee to cover the cost of monitoring the contract.

The fee is quite a hike from the current amount AMR pays the department: about $249,000.

You may recall that the "dispatch service" fee was the decisive factor in AMR winning the contract two years ago over Rockingham Ambulance. AMR offered to pay $235,000 - more than double the amount Rockingham was paying.

The aldermen acknowledged at the time that, all things being equal, the money was what gave AMR the advantage.

So, will the even larger dispatch fees this time around be a barrier to other bidders?

Fire Chief James Burkush doesn't think so. "We've already had five vendors express interest," he said, adding, "We would expect that AMR would also be in the mix."

One of the likely bidders will be CarePlus, a New Hampshire-based company that has been pressing local and state legislators to do more to prevent patients from being charged exorbitant rates from out-of-state companies. (AMR is the largest private ambulance company in the country.)

Rick Doherty, the company's vice president, said he wasn't discouraged by the RFP approved last week. "We need to gather more financial information, but we're going to do everything possible to meet the provisions of the RFP," he said.

Since ambulance rides are often covered by Medicare or Medicaid, the contracts must comply with federal anti-kickback laws.

Burkush said the amount charged for dispatch services reflects the growing costs of operating it. "We took everything into account," he said. "We've had salary increases, equipment costs, a lot goes into it."

Left blank in the proposed contract is the rate the ambulance company is authorized to charge. In AMR's current contract, the amount is 35 percent of the Medicare reimbursement rate, although in practice, this only applied to the amount a patient could be charged out of pocket.

The new contract begins Jan. 1, and the fire department expects to make its recommendation in June. Good thing ambulance companies are used to working in a hurry.

- - - - - -

City Democrats appear to be coalescing around a single challenger to the formidable Mayor Ted Gatsas: Ward 12 Alderman Patrick Arnold. The latest endorsement - and it's a biggie - comes from Alderman-At-Large Dan O'Neil, who is the longest serving member on the board and also enjoys strong support from labor unions.

"I'm proud to support Patrick's campaign for mayor because we share some important values," O'Neil said in a statement released by Arnold on Thursday. "We share the belief that our city can do better, that we need responsible leadership at City Hall, and that our leaders should always put the people's best interests first."

O'Neil joins a growing list of endorsements, including those of Aldermen Ron Ludwig and Pat Long, and school board members Sarah Ambrogi and Kathy Staub.

- - - - - -

The shared values of O'Neil and Arnold may have been on display on Tuesday, when both voted against a proposal to put the tax cap on the ballot again. They were joined by another tried and true Democrat, Garth Corriveau of Ward 6.

Corriveau and O'Neil were largely silent during the discussion, and Arnold made the point that proposing a charter amendment would be stepping on the Charter Commission's turf.

In the midst of the debate, the three left the room and returned at the same time.

Was there an informal caucus, which would seem to clash with the spirit, if not the letter, of the state's Open Meetings Law?

Arnold says it was a "coincidence."

"One might be using the restroom, another increasing their blood sugar," he said, adding there was "no discussion" of the tax cap.

Ward 4 Alderman Jim Roy, who also chafes at the tax cap but didn't support putting it on the ballot, couldn't help but take notice. "I don't go for backroom horse trading and twisting of arms," he said. "I'm not saying anything happened, but sometimes perception is reality when people disappear in the middle of a discussion. There are some questions in some people's minds."

- - - - - -

One doesn't typically think of hot-dog vendors as social service providers, but this was the premise behind John Giles' recent message to city officials.

Giles runs a hot-dog cart, and he wants the city to revise the zoning around Verizon Wireless Arena to allow peddlers in the area from 11 p.m. to 2:30 a.m.

"When kids get out of the clubs, we serve a purpose," Giles told the aldermen Tuesday. "Club-goers might have had one too many drinks. Getting something in their stomach - a hot dog, a sausage - could prevent them from getting in their car drunk."

Giles said he would only be doing his vending after events at the Verizon and wouldn't threaten concession sales. He would also be close to bars in the area.

Alderman Pat Long of Ward 3, which includes downtown, said he's working with the City Clerk's Office on the matter, and it will likely by referred to the Administration Committee.

Long said he's supportive of the idea, but it needs to be examined. "We want to make sure we don't hurt the businesses that are 24-7 there," he said. "And when you have people congregating outside bars, you can have issues with fights and what have you."

- - - - - -

Word is the job of principal at Manchester High School West is going to be reposted. District officials are not satisfied with the candidates. In the meantime, it's safe to say that John Rist will continue as principal on an interim basis, at a rate of $90 an hour.

Rist, you may recall, took the reins at West following the resignation of MaryEllen McGorry in January, which itself followed a months-long investigation that cost more than $100,000.

That the district failed to find a satisfactory candidate for a top post sounded a bit too familiar to Ward 9 school board member Art Beaudry.

"I'm very disappointed, for a district of our size, we can't find internal candidates to take over that position," he said. "This seems to happen time and again."

Ted Siefer may be reached at tsiefer@unionleader.com. Follow him on Twitter @tbsreporter.